A New Generation of Doctors Looks to Health Centers for Residency

NEW YORK - As famously portrayed on scripted TV shows, medical residencies are a critical stage of training where newly minted doctors gain hands-on experience in their chosen specialty. Faced with such a weighty decision, some rookie doctors might struggle to choose which specialty and hospital to select. But Dr. Joronia Chery knew exactly what she wanted - and it wasn't in a hospital.

"I came here because this is where I see myself making the most difference. It feels like treating my grandmother or my mother," said Dr. Chery, a first-year resident at the Institute for Family Health's Harlem location. Her voice brims with conviction, a result of years of witnessing, as a child, the healthcare gaps in her Brooklyn community, where she had to travel 30 minutes by bus to the closest community health center. Chery's words echo a shared mission among the residents and faculty of this federally qualified health center, or FQHC, residency program, to address the inequities in American healthcare, one patient at a time.

While the overwhelming majority of doctors complete their residencies in a hospital setting, for over a decade, the U.S. Health Resources and Services Administration's Teaching Health Center Graduate Medical Education program has trained physicians at FHQCs. To date, 2,027 new primary care physicians and dentists have entered the workforce after completing an FQHC-based residency, more than 80% of whom are family or internal medicine doctors. Reflecting their mission to treat everybody who comes through the door, regardless of means, FQHC residencies place a focus on delivering comprehensive, culturally competent care in underserved communities. Its mission, rooted in the Affordable Care Act, aims to meet the pressing need for primary care doctors while reshaping how and where they are trained.

Dr. Robert "Red" Schiller, who is chair of the Engelberg Department of Family Medicine at Mount Sinai Beth Israel and Vice Chair of the Department of Family Medicine and Community Health at the Icahn School of Medicine Mount Sinai Hospital, leads the Institute for Family Health's residency programs. IFH has over a dozen locations across New York City and the Hudson Valley and sees over 100,000 patients across about 450,000 visits annually. Noting the initiative's bipartisan support, he said, the goal is "to get the workforce needed to work in community health centers and take care of people who are marginalized by racism and poverty. It is to create training capacity in these sites so that they learn the skills that are necessary to make a difference."

Teaching health centers like this one stand in contrast to traditional hospital residencies. They immerse trainees in outpatient, community-based settings, prioritizing preventive, collaborative, and comprehensive care. Residents develop skills ranging from managing chronic diseases like diabetes and hypertension to navigating the intricate social determinants of health, such as housing and food insecurity. FHQC-based residencies also embody one of the many ways safety net clinics in the U.S. serve a wide variety of needs in their respective communities in addition to offering primary healthcare visits for all.

Schiller said traditional training programs prioritize work within a resident's rotation. If there is a complex outpatient case, that patient would "get basically seen by anybody else and it's a fragmented system," At his FQHC, it's the opposite. "We would figure out how to cover that patient with the same team," he said.

"At the end of the day, FHQCs are the ones that actually take care of the community," Chery said. "The cancer centers are nice, but how can you prevent cancers if you're not doing the underground work of helping stop smoking and helping people get colon cancer screenings on time… It felt like to get to the root of the problems that we're shuttling money to, we needed to go down to the basics, and this is where that happens," she said.

Dr. Esha Mehta, 29, a third-year resident, described the program's impact on her practice. "We do so much within these walls. Patients come here for everything - procedures, mental health support, even prenatal care… This really feels like a true medical home for patients," she said. "I love that about this space, because I never experienced it in medical school."

Mehta said that in assessing which residency program she wanted to attend, her choice came down to emergency medicine and the FQHC program. Noting the overlap, in terms of acting as a safety net and treating patients who aren't otherwise able to access care, she said FQHCs are able to do follow-up visits for additional health care issues, which does not exist in an emergency room setting. "We're able to really work with them and connect these patients to care," she said.

Situated in Harlem and serving patients from across New York City, the residency reflects the diversity of its community. Many residents, like Chery, intentionally choose the program because they see themselves in their patients. Fluent in French and Haitian Creole, she has bridged language gaps that might otherwise complicate care. "When a patient hears someone speaking their language, their shoulders relax. They know they're in the right place," she said.

The program's reach extends beyond the exam room. Residents participate in community walks to understand local resources and challenges, from grocery store prices to housing conditions. They also lead initiatives like centering pregnancy programs, which bring together expectant mothers for shared support and education.

Dr. Sarah Duncan, a faculty member who completed her residency at IFH emphasized how personal connections enhance trust. "Patients know we're here for the long haul. They come to see the same doctor year after year. That continuity makes all the difference," she said. Added Schiller, "Continuity is a cornerstone of primary care, specifically in family medicine."

Despite its success, the program continues to face an uncertain future. Federal funding for Teaching Health Centers is minimal, totaling less than 1% of the multi-billion dollar budget allocated to hospital-based residencies. Additionally, FQHC residency programs are funded by annual congressional appropriations and grant awards, compared to the stable, long-term Medicare-funded programs for traditional hospital-based programs.

The FQHC-based program trained 1,096 residents in 81 locations from 2023 to this year. These young doctors cared for over 792,000 patients in more than 1.2 million visits.

Schiller voiced his concerns bluntly. "If funding were cut, it would be devastating. These centers provide care for communities that hospitals often overlook. Without them, we'd see more preventable illnesses and deaths."

The stakes are high. By 2035, the U.S. is projected to face a shortage of between 35,000 to 68,000 primary care physicians according to HRSA and the U.S. Bureau of Health Workforce. Teaching Health Centers have been uniquely effective in addressing this gap, with the majority of graduates continuing to serve in underserved areas. Losing funding, faculty say, could not only jeopardize patient care but also dismantle a successful pipeline for the next generation of doctors.

Still, the residents in the program see wins each day.

Mehta shared a recent patient story that underscored her commitment to community health. "A young woman came in for a routine visit but opened up about her fears around HIV. I spent time educating her about prevention, and she decided to start PrEP. It was a small win, but it felt huge. It's moments like that that remind me why I chose this path."

Direct Relief supports health centers across the United States, including the Institute for Family Health, with medical and financial aid.

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